Tags

Type your tag names separated by a space and hit enter

Indication for hypertrophy posterior longitudinal ligament removal in anterior decompression for cervical spondylotic myelopathy.
Medicine (Baltimore). 2017 Jun; 96(23):e7043.M

Abstract

The retrospective study aimed to investigate the indication for hypertrophy posterior longitudinal ligament (HPLL) removal in anterior decompression for cervical spondylotic myelopathy (CSM). A total of 138 consecutive patients with CSM were divided into 2 groups with developmental cervical stenosis (DCS) (group S) and non-DCS (group N), according to the Pavlov ratio. These 2 groups were subdivided into 2 further subgroups, according to whether HPLL was removed or preserved: group SR (49 patients) and group SP (32 patients) in group S, group NR (21 patients) and group NP (36 patients) in group N. The modified Japanese Orthopedic Association score (mJOA), the modified recovery rate (mRR), quality of life (QoL), and relevant clinical data were used for clinical and radiological evaluation. The mJOA scores improved from 7.3 ± 2.2 to 15.0 ± 1.8 in the SR group and from 7.9 ± 2.3 to 14.2 ± 1.5 in the SP group (P = .036), with postoperative QoL significantly higher in the SR group than the SP group. A reduction in the diameter of enlarged spinal canals occurred at a significantly faster rate in the SP group compared with the SR group (P = .002). Multivariate regression analyses showed removal of HPLL correlated with mJOA scores (coefficient = 7.337, P = .002), mRR (%) (coefficient = 9.117, P = .005), PCS (coefficient = 12.129, P < .001), and MCS (coefficient = 14.31, P < .001) in the S group at 24 months postoperatively, while removal of HPLL did not correlate with clinical outcomes in the N group. The HPLL should, therefore, be removed when mobility was reduced and the spinal cord remained compressed after anterior decompression procedures in the patients with DCS. However, in non-DCS patients, it remains unclear as to whether removal of HPLL provides any clinical benefit, thus, HPLL removal may not be necessary.

Authors+Show Affiliations

aDepartment of Orthopedics, Beijing Friendship Hospital Affiliated of Capital Medical University, Beijing bDepartment of Orthopedics, Xiangya Hospital, Central South University, Changsha, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

28591038

Citation

Bai, Chengrui, et al. "Indication for Hypertrophy Posterior Longitudinal Ligament Removal in Anterior Decompression for Cervical Spondylotic Myelopathy." Medicine, vol. 96, no. 23, 2017, pp. e7043.
Bai C, Li K, Guo A, et al. Indication for hypertrophy posterior longitudinal ligament removal in anterior decompression for cervical spondylotic myelopathy. Medicine (Baltimore). 2017;96(23):e7043.
Bai, C., Li, K., Guo, A., Fei, Q., Li, D., Li, J., Wang, B., & Yang, Y. (2017). Indication for hypertrophy posterior longitudinal ligament removal in anterior decompression for cervical spondylotic myelopathy. Medicine, 96(23), e7043. https://doi.org/10.1097/MD.0000000000007043
Bai C, et al. Indication for Hypertrophy Posterior Longitudinal Ligament Removal in Anterior Decompression for Cervical Spondylotic Myelopathy. Medicine (Baltimore). 2017;96(23):e7043. PubMed PMID: 28591038.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Indication for hypertrophy posterior longitudinal ligament removal in anterior decompression for cervical spondylotic myelopathy. AU - Bai,Chengrui, AU - Li,Kanghua, AU - Guo,Ai, AU - Fei,Qi, AU - Li,Dong, AU - Li,Jinjun, AU - Wang,Bingqiang, AU - Yang,Yong, PY - 2017/6/8/entrez PY - 2017/6/8/pubmed PY - 2017/7/7/medline SP - e7043 EP - e7043 JF - Medicine JO - Medicine (Baltimore) VL - 96 IS - 23 N2 - The retrospective study aimed to investigate the indication for hypertrophy posterior longitudinal ligament (HPLL) removal in anterior decompression for cervical spondylotic myelopathy (CSM). A total of 138 consecutive patients with CSM were divided into 2 groups with developmental cervical stenosis (DCS) (group S) and non-DCS (group N), according to the Pavlov ratio. These 2 groups were subdivided into 2 further subgroups, according to whether HPLL was removed or preserved: group SR (49 patients) and group SP (32 patients) in group S, group NR (21 patients) and group NP (36 patients) in group N. The modified Japanese Orthopedic Association score (mJOA), the modified recovery rate (mRR), quality of life (QoL), and relevant clinical data were used for clinical and radiological evaluation. The mJOA scores improved from 7.3 ± 2.2 to 15.0 ± 1.8 in the SR group and from 7.9 ± 2.3 to 14.2 ± 1.5 in the SP group (P = .036), with postoperative QoL significantly higher in the SR group than the SP group. A reduction in the diameter of enlarged spinal canals occurred at a significantly faster rate in the SP group compared with the SR group (P = .002). Multivariate regression analyses showed removal of HPLL correlated with mJOA scores (coefficient = 7.337, P = .002), mRR (%) (coefficient = 9.117, P = .005), PCS (coefficient = 12.129, P < .001), and MCS (coefficient = 14.31, P < .001) in the S group at 24 months postoperatively, while removal of HPLL did not correlate with clinical outcomes in the N group. The HPLL should, therefore, be removed when mobility was reduced and the spinal cord remained compressed after anterior decompression procedures in the patients with DCS. However, in non-DCS patients, it remains unclear as to whether removal of HPLL provides any clinical benefit, thus, HPLL removal may not be necessary. SN - 1536-5964 UR - https://www.unboundmedicine.com/medline/citation/28591038/Indication_for_hypertrophy_posterior_longitudinal_ligament_removal_in_anterior_decompression_for_cervical_spondylotic_myelopathy_ L2 - http://dx.doi.org/10.1097/MD.0000000000007043 DB - PRIME DP - Unbound Medicine ER -